Botox in Gums for Nerve Pain?

I am getting ready to have botox injected into my gum due to scar tissue that has bound up a nerve and is causing me continuous pain. Have you ever heard of this?

Doctor Answers 6

Botox in gums for nerve pain

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Very interesting approach to a new use for BOTOX. Never have heard of it before. Asked Chief of Oral Surgery here. He also never heard of this but will try.

From MIAMI Dr. B

botox for neuroma

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There has been a report in Aesthetic Plastic Surgery in April 2009 that Botox injections were found to decrease hypertrophic scars that had been present for two years prior to the treatments. Possibly the same mechanism might be involved with reduction in scarring around the nerve helping decrease the pain of the neuroma, but the method of action is unknown and the study has not been reproduced as far as I am aware.

Ronald Shelton, MD
Manhattan Dermatologic Surgeon
4.9 out of 5 stars 39 reviews

Botox Can Be Used For Pain

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Botox is a neruomodulator well known for its ablilty to weaken or paralyze muscles.

When Botox is injected in nonmuscular tissue, it has very beneficial and positive effects. Some of these uses are in the salivary glands for excessive salivation, or in sweat glands in the handm, or axilla for hyperhidrosis (excessive sweating).

Botox is being used off label for pain. I have personally used it for pain in an off label fashion into arthritic joints (instead of cortisone), for nerve pains, and for reflex dystrophy.

Botox is a remarkable drug and I cannot see harm from a gum injection. I think your oral surgeon is forward thinking and I presume he/she has had experience in Botox for gum pain injections.

My gut feeling is it is safe, and not likely to migrate to anywhere unsafe.

See the abstracts below:

Clin J Pain. 2002 Nov-Dec;18(6 Suppl):S177-81.
A focused review on the use of botulinum toxins for neuropathic pain.

Argoff CE.

Cohn Pain Management Center, North Shore University Hospital, New York University School of Medicine, Bethpage, New York 11714, USA.

Understanding the pathophysiology of a pain syndrome is helpful in selecting appropriate treatment strategies. Nociceptive pain is related to damage to tissues due to thermal, chemical, mechanical, or other types of irritants. Neuropathic pain results from injury to the peripheral or central nervous system. Common examples of neuropathic pain include postherpetic neuralgia, diabetic neuropathy, complex regional pain syndrome, and pain associated with spinal cord injuries. Nociceptive pain may have similar clinical characteristics to neuropathic pain. It is also possible for acute nociceptive pain to become neuropathic in nature, as with myofascial pain syndrome. A clear benefit of botulinum toxin therapy for treatment of neuropathic pain disorders is that it often relieves pain symptoms. Although the precise mechanism of pain relief is not completely understood, the injection of botulinum toxin may reduce various substances that sensitize nociceptors. As a result, botulinum toxin types A and B are now being actively studied in nociceptive and neuropathic pain disorders to better define their roles as analgesics.

Here is another more recent study:

Toxicon. 2009 Oct;54(5):658-67. Epub 2009 Apr 5.
Intra-articular Botulinum Toxin Type A: a new approach to treat arthritis joint pain.

Mahowald ML, Krug HE, Singh JA, Dykstra D.

Rheumatology Section, Minneapolis VA Medical Center, Univ of Minnesota, MN 55417, USA.

There is a growing need for novel treatments of refractory arthritis joint pain as the aging population is expanding with many patients who are unable to undergo joint replacement surgery. We are studying the efficacy and safety of intra-articular injection of Botulinum Toxin Type A (IA-BoNT/A) into joints with arthritis pain. In several small open label studies, initial effects for IA-BoNT/A were encouraging because two thirds of the patients had more than 50% reduction in joint pain severity that was associated with a significant improvement in function. Importantly no serious adverse effects of IA-BoN/A were noted. Based on these initial results, we have completed two pilot randomized controlled trials in painful shoulder joints and painful knee joints. In the shoulder study, IA-BoNT/A produced a significant decrease in shoulder pain severity at one month (6.8-4.4 on VAS, p=.002) that was also significantly better than the non-significant change after IA-Saline placebo (1.6 unit difference favoring IA-BoNT/A, p=.014). In the knee study IA-BoNT/A produced a significant 48% decrease in McGill Total Pain Score at one month (p=.01 1) that was still significant at 3 mo after injection (p=.002). There was a strong placebo response in one third of those but the decrease in pain severity was not significant. We are currently conducting a RCT of IA-BoNT/A for painful prosthetic knee joints. Based on these initial studies of IA-BoNT/A we have gone 'back to the bench' to standardize a menu of pain behaviors for mice with acute inflammatory arthritis pain and chronic inflammatory arthritis pain. IA-BoNT/A significantly reduced arthritis joint tenderness (evoked pain score) in acute and chronic inflammatory arthritis and normalized impaired spontaneous wheel running in mice with chronic inflammatory arthritis but not in those with acute inflammatory arthritis. With these models of arthritis and pain behavior methods we will be able to screen potential intra-articular analgesics, define dose response curves and injection schedule, and study the relationships of articular pain and loss of function.

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This appears to be a completely non-standard approach to this issue

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One problem with being on the cutting edge is that occasionally you bleed.  Do a google search on this treatment and you will see that there is not a whole lot on this topic.  It does not mean that it won't work.  

However, sensory changes after BOTOX treatment are commonly encountered.  This would suggest that injecting the gums with BOTOX may not accomplish the goal.  The treatment will be somewhat uncomfortable and you will be out the cost of treatment.  Ask your dentist if you can have your money back if the treatment does not work.

Kenneth D. Steinsapir, MD
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

Botox and Nerve Pain

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I have never heard of this before. Botox is a paralytic by nature - it works by blocking neuromuscular junctions so that the muscle cannot fire. It really should do nothing to nerve sensation pain/ neuroma since these are different receptors. I would be wary of someone suggesting this as a treatment option.

Botox use for Gum Pain

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I am familiar with a lot of off-label uses of Botox (such as use for anal fissures, facial ticks, cluster headaches etc) but use in neuromas secondary to gum surgery is not one of them. You may want to consult SEVERAL Oral surgeons to see what they suggest before proceeding.

Peter A. Aldea, MD
Memphis Plastic Surgeon

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